Outcome of patients who refuse transfusion after cardiac surgery: A natural experiment with severe blood conservation

Gregory Pattakos, Colleen G. Koch, Mariano E. Brizzio, Lillian H. Batizy, Joseph F. Sabik, Eugene H. Blackstone, Michael S. Lauer

Research output: Contribution to journalArticle

Abstract

Background: Jehovah's Witness patients (Witnesses) who undergo cardiac surgery provide a unique natural experiment in severe blood conservation because anemia, transfusion, erythropoietin, and antifibrinolytics have attendant risks. Our objective was to compare morbidity and long-term survival of Witnesses undergoing cardiac surgery with a similarly matched group of patients who received transfusions. Methods: A total of 322 Witnesses and 87 453 non- Witnesses underwent cardiac surgery at our center from January 1, 1983, to January 1, 2011. All Witnesses prospectively refused blood transfusions. Among non- Witnesses, 38 467 did not receive blood transfusions and 48 986 did. We used propensity methods to match patient groups and parametric multiphase hazard methods to assess long-term survival. Our main outcome measures were postoperative morbidity complications, inhospital mortality, and long-term survival. Results: Witnesses had fewer acute complications and shorter length of stay than matched patients who received transfusions: myocardial infarction, 0.31% vs 2.8% (P = .01); additional operation for bleeding, 3.7% vs 7.1% (P = .03); prolonged ventilation, 6% vs 16% (P ≤ .001); intensive care unit length of stay (15th, 50th, and 85th percentiles), 24, 25, and 72 vs 24, 48, and 162 hours (P < .001); and hospital length of stay (15th, 50th, and 85th percentiles), 5, 7, and 11 vs 6, 8, and 16 days (P < .001). Witnesses had better 1-year survival (95%; 95% CI, 93%-96%; vs 89%; 95% CI, 87%-90%; P=.007) but similar 20-year survival (34%; 95% CI, 31%-38%; vs 32% 95% CI, 28%-35%; P=.90). Conclusions : Witnesses do not appear to be at increased risk for surgical complications or long-term mortality when comparisons are properly made by transfusion status. Thus, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival.

Original languageEnglish (US)
Pages (from-to)1154-1160
Number of pages7
JournalArchives of internal medicine
Volume172
Issue number15
DOIs
StatePublished - Aug 13 2012
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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